Provider First Line Business Practice Location Address:
525 14TH ST
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-7544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-238-1783
Provider Business Practice Location Address Fax Number:
619-238-1873
Provider Enumeration Date:
11/23/2009